在跨性别患者中对自杀事件风险模型的前景验证
Robert A Becker1, Colin G Walsh1
1Vanderbilt University Medical Center, Nashville, Tennessee, USA.
AMIA ... Annual Symposium proceedings. AMIA Symposium
|February 23, 2026
概括
自杀风险预测模型对跨性别个体的准确性有限,假负值高,校准错误. 针对性验证和小组意识策略对于边缘化群体的公平风险评估至关重要.
科学领域:
- 临床信息学 临床信息学
- 精神病学是一个精神病学.
- 健康 公平 卫生 公平
背景情况:
- 自杀风险预测模型对于早期干预至关重要.
- 他们在代表性不足的群体中的表现,比如跨性别者,往往是不确定的.
- 一般人口模型可能无法准确地服务于多种不同的人口分组.
研究的目的:
- 评估VSAIL自杀风险预测模型在变性人群中的现实世界表现.
- 评估模型在这个特定人群中的区分能力,校准和临床实用性.
- 为了确定局限性,并为改善预测性公平的策略提供信息.
主要方法:
- 通过使用电子健康记录数据识别了变性人.
- 通过手动图表审查确认了跨性别身份.
- 使用AUROC,AUPRC,Brier分数和Spiegelhalter的z统计等指标来评估VSAIL模型的性能.
主要成果:
- 该VSAIL模型显示了适度的区分能力 (AUROC=0.777,AUPRC=0.115).
- 观察到明显的虚假阴性率 (77%),降低了临床效用.
- 该模型显示了显著的校准错误 (Brier=0.023,p<0.001),表明可靠性不佳.
结论:
- 一般人群训练的自杀风险模型在准确预测跨性别患者的风险方面存在局限性.
- 有针对性的子组验证对于确保预测模型的有效性和公平性至关重要.
- 持续的算法监测和小组意识建模是必要的,以改善边缘化群体的自杀风险预测.
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